Flu Consent Form

Flu Consent Form

  • Dear Parents,

    Outpatient Medical Center Inc. will be hosting a flu clinic inside of your child’s school. During this time your child will be able to receive their flu vaccine. Please fill out the following information if you would like your child to receive a flu vaccine. We will bill your insurance. If you do not have insurance the cost is $20.00 for the flu vaccine.
  • Questions You Must Answer

  • Date Format: MM slash DD slash YYYY